We began with a simple idea in 2006, to provide a memory service within Primary Care. It worked and proved to be well received by patients and relatives, effective and absurdly cost inexpensive. This system improved the service and reduced expenditure by £500,000 each year. Extending the approach to people with frailty arising from multiple pathologies was also effective and reduced expenditure by another £500,000. The memory service continues, though I have not been involved as a clinician these last 18 months.

Day by day I read newspaper headlines which declare that the NHS is overwhelmed and under resourced. Ian Greaves continues to share emails which describe positive and creative initiatives at Gnosall which are designed to make things work. This week I was able to visit the Practice to hear more about the work. It was good to spend time at Gnosall with Ian, looking very fit, and colleagues who are involved in these new developments and their vision for more.

The ambition goes beyond our humble model which brought clinical skill to bear where it is most effective and which shortcuts red tape by a patient and family focus. That has to be the essence of any successful system, but these guys are looking wider. Their mission is to create a workforce which is equipped to meet the needs of current and future patients.

This is a modest and sober ambition but not one which is achieved by present training and retention regimes. Pouring millions of pounds into new medical schools to generate more doctors has not worked. The doctors who are created do not want to practise in a way which matches the needs of the UK population. They are trained to value work with single pathologies and the latest hi-tech techniques. A large proportion of UK medical graduates are going abroad. https://www.theguardian.com/society/2015/aug/23/new-doctors-leave-nhs-for-better-life-abroad

Colleagues at Gnosall have taken up this challenge and are addressing it on several fronts.

With academic partners training doctors to care for patients who are frail. With other partners to support apprenticeships for carers, to train Physician Assistants and to equip experienced nurses for greater independence.

Practices which have not been able to recruit or retain doctors now can look to balancing their portfolio by making use of these alternatively skilled professionals.

Patients are partners in these developments which are accepted, trusted and liked. People with long-term needs are trained to share responsibility for managing their conditions.

I have become used to the trust, vision and confidence which pervades the Gnosall Practice but they tell me now that the unit of delivery is being increased from single practices such as this. I wonder if this is a strong a model as the small cell, three tiered system which we described from the memory service.

The vision is one for a whole population health where everyone plays their part, language is kept simple and transparent and best use of all resources is guaranteed by recurrent scrutiny and revision. It looks for a fair allocated budget based on predicted need from demographic calculations. This budget is allocated to be used at the discretion of the locality rather than being hamstrung by imposed formulas from elsewhere.

For patients in the greatest number and greatest need, including those with dementia and related disorders, Gnosall holds a torch to light a way through the darkness of despair. We have much to learn and we must get Ian and these colleagues to share more in detail of what to do and how to do it.